Can the bowel substitute for the kidney in advanced renal failure?

Friedman, Eli A.

doi:10.1185/03007990903069173

Cited by 14 publications

(11 citation statements)

References 24 publications

(17 reference statements)

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“…Another effort was to use the gut as a therapeutic target and transform the bowel into a ‘substitute kidney’; efforts to use colonic gavage and somewhat more effective efforts to bind nitrogen compounds to solvents (charcoal, oxystarch) failed to yield impressive results [22,23]. …”

Section: The Gut Contributes To the Uremic Syndromementioning

confidence: 99%

Intestinal-Renal Syndrome: Mirage or Reality?

Ritz

2011

Blood Purif

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The recent interest in the role of the intestine in the cardiovascular stability of uremic patients, specifically on dialysis, but potentially also in chronic kidney disease, must be seen against the background of the recent great interest in the role of the gut in chronic heart failure [Curr Opin Clin Nutr Metab Care 2008;11:632–639]. There has been a long-standing interest in the role of the intestine in renal failure, mainly concerning the role of metabolites of bacterial metabolism in the gut as potential uremic toxins. This area has recently been given a new twist by the finding that increased endotoxin concentrations in the blood of dialyzed patients are associated with hypotensive episodes and myocardial ‘stunning’. Recent studies suggest that intradialytic underperfusion of myocardial areas, the so-called stunning, may be related to the entry of bacterial endotoxin and/or cytokines across the mucosal barrier into the circulation, where they have a negative impact on myocardial function (and presumably beyond the negative cardiac side effect also contribute to catabolism and malnutrition). Entry of bacterial endotoxin during dialysis sessions is presumably the result of intermittent underperfusion of the intestine if the effective blood volume is rapidly reduced causing breakdown of the mucosal barrier. Apart from the impact on myocardial perfusion, the entry of bacterial endotoxin and/or cytokines across the mucosal barrier may also contribute to malnutrition, wasting and reduced life expectancy in hemodialyzed patients. Such a causal relationship is absolutely plausible in view of an extensive literature on congestive heart failure where clinical and experimental evidence indicates that bacterial endotoxin and/or cytokines may escape from a hypoperfused edematous gut, entering the circulation, triggering an inflammatory response, upregulating circulating cytokines and interfering with the function of the heart through several pathogenic mechanisms.

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Section: The Gut Contributes To the Uremic Syndromementioning

confidence: 99%

Intestinal-Renal Syndrome: Mirage or Reality?

Ritz

2011

Blood Purif

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“…In CKD patients, the imbalance mainly occurs in the colon, presenting as decreased levels of probiotics such as Lactobacillus and Bifidobacteria and increased pathogenic bacteria such as Escherichia coli and Enterococcus [20, 21]. Under these conditions, bacteria (mostly E. coli ) produce numerous toxins from glycolysis of the retained proteins.…”

Section: Discussionmentioning

confidence: 99%

Effect of astragaloside IV on indoxyl sulfate-induced kidney injury in mice via attenuation of oxidative stress

Luo

Zou

et al. 2018

BMC Pharmacol Toxicol

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BackgroundAstragalus membranaceus, a traditional Chinese medicine (TCM), has been widely used in the treatment of chronic kidney disease (CKD) in China. Astragaloside IV is one of the major compounds of Astragalus membranaceus. Recent research has shown that astragaloside IV demonstrates pharmacological effects, such as anti-inflammatory, anti-fibrotic and anti-oxidative stress activities. Our aim was to investigate the effects of astragaloside IV on indoxyl sulfate (IS)-induced kidney injury in vivo, and to study the underlying mechanism.MethodsForty C57BL/6 mice with ½ nephrectomy were divided into four groups: control group (n = 10), IS group (n = 10), IS plus 10 mg/kg of astragaloside IV group (n = 10) and IS plus 20 mg/kg of astragaloside IV group (n = 10). IS intraperitoneal injection and astragaloside IV treatment were administered continuously for 1 month. Next, the blood urea nitrogen (BUN) level, serum IS level, tubulointerstitial injury, renal oxidative stress and inflammatory injury were assessed.ResultsThe IS intraperitoneal injection mouse group showed increasing levels of serum IS, BUN, tubulointerstitial injury, renal oxidative stress and inflammatory injury. Astragaloside IV treatment couldn’t reduce the serum IS level or renal nuclear factor-κB and interleukin-1β levels. However, 20 mg/kg astragaloside IV treatment reduced the BUN level and significantly attenuated IS-induced tubulointerstitial injury. Renal oxidative stress was decreased by the administration of astragaloside IV.ConclusionsThese results suggest that astragaloside IV prevents IS-induced tubulointerstitial injury by ameliorating oxidative stress and may be a promising agent for the treatment of uremia toxin-induced injury.Electronic supplementary materialThe online version of this article (10.1186/s40360-018-0241-2) contains supplementary material, which is available to authorized users.

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“…Activated charcoal in doses of 30 to 45 gram daily (15 g in a glass of water with each meal) was administered. Intestinal dialysis and use of adsorbent such as activated charcoal or AST 120 with some affinity to intestinal nitrogenous waste products, is another known method of decreasing the need for dialysis in ESRD patients (15). Studies of intestinal dialysis have shown a daily flow of 71 grams of urea, 2.9 grams of creatinine, 2.5 grams of uric acid and 2.0 grams of phosphate into the intestinal fluid (16).…”

Section: Discussionmentioning

confidence: 99%

“…Studies of intestinal dialysis have shown a daily flow of 71 grams of urea, 2.9 grams of creatinine, 2.5 grams of uric acid and 2.0 grams of phosphate into the intestinal fluid (16). Accordingly, various invasive and noninvasive attempts including external gut fistula, intestinal dialysis, induced diarrhea, and administration of oral sorbents and/or encapsulated urease enzyme have been made to extract uremic waste from the gastrointestinal tract (2,3,(7)(8)(9)(10)(11)(12)(13)(14)(15). The second part of our protocol was the use of prebiotic.…”

Section: Discussionmentioning

confidence: 99%

Dialysis Free Protocol for Some End Stage Renal Disease Patients (Khosroshahi Protocol)

Khosroshahi

Kalantar‐Zadeh

2012

FFHD

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ABSTRACT:Background: The number of patients with End Stage Renal Disease (ESRD) is growing annually around the world. Provision of renal replacement therapy in the form of dialysis and transplant is relatively expensive. Recent studies have shown no survival benefit of early initiation of dialysis. Given recent outcome data of the timing of dialysis treatment and the expenses and logistics of hemodialysis procedure have stimulated research on alternative strategies. The aim of this study is to introduce another type of renal replacement therapy for selective patients with advanced chronic kidney disease (CKD). Methods:In a case series we used a so-called "dialysis free protocol" consisting of a low protein diet, uremic toxin adsorbents, and prebiotics for selective ESRD patients who had dialysis access constraints or did not agree placement of hemodialysis vascular access or peritoneal dialysis catheter.Findings: clinical and biochemical results of this study showed that these patients were not deteriorating during the study period and Blood Urea Nitrogen (Bun) & serum creatinin levels were not elevated in these months. Participating patients were relatively well throughout the study without signs of florid uremia and without a need for emergent or urgent dialysis. Conclusion:We conclude that our proposed dialysis free protocol reduces the need for dialysis treatment at least transiently. Whether this protocol can reduce the need for dialysis treatment requires additional studies.

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Can the bowel substitute for the kidney in advanced renal failure?

Cited by 14 publications

References 24 publications

Intestinal-Renal Syndrome: Mirage or Reality?

Intestinal-Renal Syndrome: Mirage or Reality?

Effect of astragaloside IV on indoxyl sulfate-induced kidney injury in mice via attenuation of oxidative stress

Dialysis Free Protocol for Some End Stage Renal Disease Patients (Khosroshahi Protocol)

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